The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion

Percepción del paciente mayor polimedicado sobre el rol del farmacéutico comunitario

Introducción: Actualmente casi un 80% del gasto sanitario español corresponde a las personas mayores de 65 años que, debidoa su pluripatología, se convierten en pacientes polimedicados. El farmacéutico comunitario es uno de los agentes de salud que puede ayudar a controlar este gasto y mejorar la calidad deluso de los medicamentos debido a su cercanía y accesibilidad, aunque actualmente sólo se le reconozca un rol dispensador demedicamentos. Objetivos: Explorar la percepción que tiene el paciente mayor polimedicado sobre el rol del farmacéutico. Material y métodos: Se utilizó un método exploratorio basado en la investigación cualitativa, usando como medio de obtención deinformación la entrevista semiestructurada y como marcos teóricos la Teoría del Rol complementada con la Teoría de las Creenciasen Salud. Resultados: Los pacientes mayores polimedicados identifi cancon el rol de profesional sanitario principalmente a su médicode cabecera y al personal de enfermería, relegando al farmacéuticoa funciones de índole menor y, sobre todo, con un rol dispensador de medicamentos y productos sanitarios, aunque resaltan la gran accesibilidad y la confi anza que tienen con este profesional. Conclusión: Los pacientes mayores polimedicados en España esperan del farmacéutico un buen trato y un rol dispensador. Esto puede deberse a la baja expectativa que se tiene del farmacéutico para realizar servicios profesionales distintos de los clásicos (dispensación). Los farmacéuticos deberían empezar a cambiar su rol actual implantando servicios para que la percepcióndel paciente cambie

Percepción del paciente mayor polimedicado sobre el rol del farmacéutico comunitario

Introducción: Actualmente casi un 80% del gasto sanitario español corresponde a las personas mayores de 65 años que, debidoa su pluripatología, se convierten en pacientes polimedicados. El farmacéutico comunitario es uno de los agentes de salud que puede ayudar a controlar este gasto y mejorar la calidad deluso de los medicamentos debido a su cercanía y accesibilidad, aunque actualmente sólo se le reconozca un rol dispensador demedicamentos. Objetivos: Explorar la percepción que tiene el paciente mayor polimedicado sobre el rol del farmacéutico. Material y métodos: Se utilizó un método exploratorio basado en la investigación cualitativa, usando como medio de obtención deinformación la entrevista semiestructurada y como marcos teóricos la Teoría del Rol complementada con la Teoría de las Creenciasen Salud. Resultados: Los pacientes mayores polimedicados identifi cancon el rol de profesional sanitario principalmente a su médicode cabecera y al personal de enfermería, relegando al farmacéuticoa funciones de índole menor y, sobre todo, con un rol dispensador de medicamentos y productos sanitarios, aunque resaltan la gran accesibilidad y la confi anza que tienen con este profesional. Conclusión: Los pacientes mayores polimedicados en España esperan del farmacéutico un buen trato y un rol dispensador. Esto puede deberse a la baja expectativa que se tiene del farmacéutico para realizar servicios profesionales distintos de los clásicos (dispensación). Los farmacéuticos deberían empezar a cambiar su rol actual implantando servicios para que la percepcióndel paciente cambie

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia.

INTRODUCTION:With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods. METHODS AND ANALYSIS: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments. ETHICS AND DISSEMINATION:Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study

Background: Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and morta

How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia

The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to many aspects of life in Australia and globally. This includes actual and potential future impacts on Australia's three national screening programs for breast, bowel and cervical cancer. These programs aim to improve cancer outcomes through an organised approach to the early detection of cancer and precancer in asymptomatic populations. The design of each program varies according to biological differences in the three cancers, the available screening technology, the target population, and variations in their administration of Australia's federal, state and territory jurisdictions. The observed and potential impacts of COVID-19 on these programs, and on related activities such as the current national enquiry into lung cancer screening feasibility, therefore vary significantly. This article focuses on observed short-term impacts, adaptations and the longer-term outlook for cancer screening in relation to COVID-19. It summarises potential responses to minimise the harms of disruptions caused by COVID-19, and highlights research and policy opportunities in the pandemic response and recovery which could inform and accelerate optimisation of cancer screening in the long term